scholarly journals Radiotherapy for Elderly Patients Aged ≥75 Years with Clinically Localized Prostate Cancer—Is There a Role of Brachytherapy?

2018 ◽  
Vol 7 (11) ◽  
pp. 424 ◽  
Author(s):  
Hideya Yamazaki ◽  
Koji Masui ◽  
Gen Suzuki ◽  
Satoaki Nakamura ◽  
Norihiro Aibe ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Elderly Patients ◽  
Risk Group ◽  
The Elderly ◽  
Elderly Group ◽  
Localized Prostate Cancer ◽  
Control Group ◽  
Healthy Elderly ◽  
Gu Toxicity

We compared radiotherapy outcomes between 241 elderly patients aged ≥75 years and 867 younger controls (age <75 years) with clinically localized prostate cancer. The elderly group showed an equivalent actuarial seven-year biochemical failure-free survival rate (7y-bNED) (94.9%) to the younger control group (96.4%, p = 0.593). The incidence of late genitourinary (GU) and gastrointestinal (GI) toxicities grade ≥2 was also similar between the elderly and younger cohorts, while no grade ≥4 adverse events occurred. We also examined the role of brachytherapy (BT) in the elderly group, in comparison with image-guided intensity-modulated radiotherapy (IG-IMRT). BT showed superior 7y-bNED (94.1%) than IG-IMRT (84.6%, p = 0.0183) in elderly patients, which was 100% (100% for BT and 100% for IG-IMRT, p > 0.999) for the low-risk group, 94.6% (92.8% and 100%, p = 0.203) for the intermediate-risk group, and 80.5% (91.2% and 73.6%, p = 0.0195) for the high-risk group. BT showed higher GU toxicity and equivalent GI toxicity to IG-IMRT. In conclusion, elderly patients showed bNED and toxicity that were equivalent to those observed in younger controls, and BT is a plausible option also for healthy elderly with potential to improve bNED, with higher but acceptable GU toxicity.

Radical Cystectomy in Elderly Patients

1993 ◽  
Vol 60 (1) ◽  
pp. 19-22
Author(s):  
P. Bassi ◽  
M. Gholam Alipour ◽  
G.L. Drago Ferrante ◽  
N. Piazza ◽  
N. Panza ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Length Of Hospital Stay ◽  
Wound Dehiscence ◽  
The Elderly ◽  
Elderly Group ◽  
Medical Complications ◽  
Control Group ◽  
Pelvic Hematoma

Radical cystectomy is the most common treatment for deeply invasive bladder cancer; due to reported operative risks, concerns have been expressed regarding the suitability of this operation in elderly patients. We reviewed the morbility and mortality rates in 50 patients aged 70 years and over (elderly group), undergoing radical cystectomy and urinary diversion, to verify if this procedure could be considered as initial treatment in older-age patients. The findings were compared with those observed in 50 patients aged 40 to 69 years (control group). In the elderly group there was no operative mortality; however 2 patients (4%) died post-operatively due to pulmonary embolism and multi-organ-failure syndrome respectively. Four patients (8%) were re-operated due to intestinal obstruction (2 pts), pelvic hematoma (1 pt) and wound dehiscence (1 pt). Wound separation was the more frequent complication (15%); 6% of patients experienced extended intestinal atonia. The length of hospital stay was 17.1 days. In the control group, surgical complications were comparable to those observed in the elderly group: furthermore medical complications were more frequent. In conclusion, these data suggest that radical cystectomy and urinary diversion can be safely performed in the elderly. Radical surgery is an effective treatment modality for elderly individuals who are in reasonably good general health. A higher incidence of medical complications must be expected in elderly patients.

scholarly journals Prehabilitation Program in Elderly Patients: A Prospective Cohort Study of Patients Followed Up Postoperatively for Up to 6 Months

2021 ◽  
Vol 10 (19) ◽  
pp. 4500
Author(s):  
Claire Malot ◽  
Astrid Durand-Bouteau ◽  
Nicolas Barizien ◽  
Antoine Bizard ◽  
Titouan Kennel ◽  
...  
Keyword(s):  
Cohort Study ◽  
Elderly Patients ◽  
The Elderly ◽  
Elderly Group ◽  
Control Group ◽  
Functional Capabilities ◽  
Observational Cohort ◽  
6 Minute Walk Test ◽  
The Impact ◽  
Minute Walk

The preoperative period may be an opportune period to optimize patients’ physical condition with a multimodal preoperative program. The impact of a “prehabilitation” program on elderly patients is discussed. This mono-center observational cohort study included consecutively 139 patients planned for major abdominal and thoracic surgery, with 44 in the control group (age < 65) and 95 in the elderly group (age > 65). All patients followed a “prehabilitation” program including exercise training, nutritional optimization, psychological support, and behavioral change. Seventeen patients in the control group and 45 in the elderly group completed the study at six months. The 6-minute walk test (6 MWT) increased in both groups from the initial evaluation to the last (median value of 80 m (interquartile range 51) for those under 65 years; 59 m (34) for the elderly group; p = 0.114). The 6 MWT was also similar after one month of prehabilitation for both populations. The rate of postoperative complications was similar in the two groups. Prehabilitation showed equivalence in patients over 65 years of age compared to younger patients in terms of increase in functional capabilities and of postoperative evolution. This multimodal program represents a bundle of care that can benefit a frailer population.

Assessment of Influence of Smoking, Drinking, Leukoplakia and Dental Irritation on Local Control of Early Oral Tongue Carcinoma Treated with Brachytherapy: Age and Dental Factors are Potential Prognostic Factors

2009 ◽  
Vol 95 (4) ◽  
pp. 461-466 ◽  
Author(s):  
Hideya Yamazaki ◽  
Takehiro Inoue ◽  
Ken Yoshida ◽  
Tadayuki Kotsuma ◽  
Yasuo Yoshioka ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Elderly Patients ◽  
Local Control ◽  
Tongue Cancer ◽  
The Elderly ◽  
Local Control Rate ◽  
Factor Group ◽  
Elderly Group ◽  
Control Group ◽  
Oral Tongue

Background To examine the background characteristics of elderly patients (65 years or older) with node-negative mobile tongue cancer (T1-2N0M0) who showed worse local control than a younger group. Materials and methods We retrospectively analyzed background data for 265 patients treated with brachytherapy with or without external radiotherapy between 1967 and 1999. We examined dental factors (such as irritation by prosthesis), leukoplakia, tobacco smoking and alcohol consumption for comparisons between the elderly (age ≥65 years; n = 83) and a control group (64 years or younger; n = 182). Results The elderly patients showed a worse outcome than the control group (respectively 86% and 70% at 5 years; P <0.05). Incidence of dental factors tended to be higher for elderly patients (53%) than the control group (40%, P = 0.07). Dental factors proved to have prognostic importance for local control. Five-year local control rate was 85% for patients with and 76% for patients without dental factors (P = 0.04). The elderly group positive for dental factors showed a lower 5-year local control rate (61%) than the other three groups [(elderly without the dental factor (–) group (80%), control with the dental factor (+) group (84%), and control without the dental factor (–) group (87%)] (P <0.05). Leukoplakia was found more frequently in the control (23%) than in the elderly group (5%) (P = 0.006) but had no effect on treatment outcome. Conclusions Age and dental factors (including prosthesis irritation) are potentially important prognostic factors for local control of oral tongue cancer treated with brachytherapy, especially for elderly patients.

scholarly journals Comparative effectiveness of surgery and radiotherapy for survival of clinically localized prostate cancer patients: A population-based coarsened exact matching retrospective cohort study

2019 ◽  
Author(s):  
Masato Yasui ◽  
Masahiko Sakaguchi ◽  
Ryousuke Jikuya ◽  
Sohgo Tsutsumi ◽  
Tomoyuki Tatenuma ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cohort Study ◽  
Elderly Patients ◽  
Cancer Patients ◽  
The Elderly ◽  
Population Based ◽  
Localized Prostate Cancer ◽  
Exact Matching ◽  
Coarsened Exact Matching ◽  
Significant Difference

Abstract Background. Radical prostatectomy and radiotherapy are currently the main treatment options for localized prostate cancer. However, not yet a large cohort study of comparison between surgery and radiation has been investigated in Japan nor Asia. Objective of this study was to compare the survival outcome between surgery and radiotherapy among patients with clinically localized prostate cancer and in the elderly and young patients. Methods. We retrospectively evaluated survival outcomes of localized prostate cancer patients (age at diagnosis ≤79 years, cT1-3) initially treated with surgery or radiotherapy. Data were collected from the population-based cancer registry of Kanagawa Prefecture, Japan. A 1:1 coarsened exact matching of age at diagnosis, clinical T stage, and cancer differentiation was made between the two treatment groups. Patients were also categorized into two groups by age at a cut-off of 70 years for analysis. Results. The cohort comprised 4,810 patients aged 50-79 years. No significant difference in CSS was observed between the two groups (p=0.612), but the surgery group had significantly better prognosis in OS (p=0.004). When stratified for age, similar tendencies were seen in the elderly group (aged 70-79 years) (p=0.961 and p=0.007, respectively). By contrast, no significant difference in either CSS or OS was found in the younger group (p=0.550 and p=0.408, respectively). Intrinsic deaths were more likely to occur in elderly patients treated with radiotherapy than in those undergoing surgery (69.3% vs 78.2%, p=0.128).Conclusions. Our data suggests that surgery provided significantly better OS than radiotherapy, particularly among the elderly. However, radiotherapy may be more appropriate in elderly patients due to less invasiveness of the procedure. Prospective trials evaluating these therapies are warranted.

PS01.181: ESOPHAGECTOMY FOR ESOPHAGEAL CARCINOMA TO ELDERLY PATIENTS OVER 75 YEARS OLD

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 100-101
Author(s):  
Naoto Ujiie ◽  
Yusuke Taniyama ◽  
Tadashi Sakurai ◽  
Takahiro Heishi ◽  
Chiaki Sato ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Survival Rate ◽  
Elderly Patients ◽  
Esophageal Carcinoma ◽  
Operation Time ◽  
The Elderly ◽  
Elderly Group ◽  
Control Group ◽  
And Control

Abstract Background Recently, operation cases of elderly patients are increasing in esophageal carcinoma. Because elderly patients often have pre-existing disease and may easily cause postoperative complications, it is necessary to consider whether surgical treatment is appropriate for those elderly patients. The aim of this study is to investigate the safety of esophagectomy for elderly patients with esophageal carcinoma. Methods All 483 patients who underwent esophagectomy for esophageal carcinoma between April 2007 and March 2015 were included in this study. Patients were divided into two groups: elderly group (over 75 years old: n = 72) and control group (under 75 years old: n = 411). The short and long-term outcomes were retrospectively examined to those groups. Results In the elderly group, their median age was 77 [75–85] and all of their performance status was 0 or 1, except 4 patients. 66 cases of the elderly group had some comorbidity, which was significantly higher than that of the control group (93.0 vs. 80.2%, P = 0.007). Pre-surgical treatment was performed to 38.9% of the elderly group, whereas 58.9% in the control group (P = 0.002). No significant differences were demonstrated in clinical stage, occupation site, histological type and pathological stage between these groups. The operation time was relatively shorter in the elderly group compare to the control group (549 vs. 585min, P = 0.018). The number of dissected lymph node was also smaller in elderly group (31 vs. 35, P = 0.048). The postoperative complications such as pneumonia, recurrent laryngeal nerve paralysis did not show any difference between these groups. The 5-year overall survival rate (OS) and the 5-year disease specific survival rate (DSS) also did not show statistical differences between the elderly and control group (OS: 53.0 vs. 57.0%, P = 0.765; DSS: 64.6 vs. 62.7%, P = 0.605). Conclusion Between elderly and control group, there was no difference in postoperative complication and long-term survival. This study confirmed the safety of esophagectomy for elderly patients with esophageal carcinoma by reducing treatment stress such as neoadjuvant therapy, extended operation time and extensive lymphadenectomy. Disclosure All authors have declared no conflicts of interest.

Good Patient and Technique Survival in Elderly Patients on Continuous Ambulatory Peritoneal Dialysis

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 196-201 ◽  
Author(s):  
Philip Kam-Tao Li ◽  
Man Ching Law ◽  
Kai Ming Chow ◽  
Chi-Bon Leung ◽  
Bonnie Ching-Ha Kwan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Elderly Patients ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Patient Survival ◽  
Self Care ◽  
The Elderly ◽  
Elderly Group ◽  
Control Group ◽  
Technique Survival ◽  
Esrd Patients

The aging population has significant implications for the community. The increasing number of elderly end-stage renal disease (ESRD) patients presses the renal team to find an appropriate management plan. We used a retrospective analysis to study the effectiveness of continuous ambulatory peritoneal dialysis (CAPD) in elderly ESRD patients. Of the 328 CAPD patients recruited for the study, 121 were in the elderly group (≥ 65 years of age), and 207 were in the control group (under 65 years of age). Median age in the elderly group was 71 years, and in the control group, 51 years. The elderly group had a higher prevalence (54.5%) of diabetes mellitus. The 2-year and 5-year rates of patient survival were 89.3% and 54.8% respectively in the elderly group and 92.2% and 62.9% in the control group ( p = 0.19). The 2-year and 5-year rates of technique survival were 84.0% and 45.7% respectively in the elderly group and 80.9% and 49.1% in the control group ( p = 0.75). The probability of a 12-month peritonitis-free period was 76.6% in the elderly group and 76.5% in the control group ( p = 0.75). One hundred elderly patients (82.6% of the group) performed their CAPD exchanges by themselves. We observed no significant difference in clinical outcome—including patient survival, technique survival, and peritonitis-free period—between the elderly self-care CAPD and the elderly assisted CAPD groups. In elderly ESRD patients, CAPD is an effective dialysis modality. A slightly longer training time is to be expected for elderly patients. Self-care CAPD for elderly patients who are capable of performing their own exchanges provides them with an independent home life.

Craniofacial resections in the elderly: an outcome study

2004 ◽  
Vol 101 (6) ◽  
pp. 935-943 ◽  
Author(s):  
Stephen J. Hentschel ◽  
Remi Nader ◽  
Dima Suki ◽  
Amer Dastgir ◽  
David L. Callender ◽  
...  
Keyword(s):  
Elderly Patients ◽  
The Elderly ◽  
Elderly Group ◽  
Cancer Center ◽  
Control Group ◽  
Disease Specific Survival ◽  
Systemic Complications ◽  
Content Type ◽  
Disease Specific ◽  
Fine Print

Object. The elderly population is increasing in number and is healthier now than in the past. The purpose of this study was to examine complications and outcomes following craniofacial resection (CFR) in elderly patients and to compare findings with those of a matched younger cohort. Methods. All patients 70 years of age or older undergoing CFR at the M. D. Anderson Cancer Center (elderly group) between December 1992 and July 2003 were identified by examining the Department of Neurosurgery database. A random cohort of 28 patients younger than 70 years of age (control group) was selected from the overall population of patients who underwent CFR. There were 28 patients ranging in age from 70 to 84 years (median 74 years). Major local complications occurred in seven elderly patients (25%) and in six control patients (21%) (p = 0.75), and major systemic complications occurred in nine elderly patients (32%) and in three control patients (11%) (p = 0.05). There was one perioperative death in both groups of patients. The median duration of disease-specific survival for the elderly patients was not reached (mean 6.8 years); however, it was 8.3 years for control patients (p = 0.24). Predictors of poorer overall survival from a multivariate analysis of the elderly group included presence of cardiac disease (p = 0.005), a major systemic perioperative complication (p = 0.03), and a preoperative Karnofsky Performance Scale score less than 100 (p = 0.04). Conclusions. In this study of elderly patients who underwent CFR, there was no difference in disease-specific survival when compared with a matched cohort of younger patients. There was, however, an increased incidence of perioperative major systemic complications in the elderly group.

scholarly journals Assessment of Functions of the Autonomic Nervous System in the Elderly with Different Comorbid Factors

2020 ◽  
Author(s):  
Sushma S. ◽  
Medha Y Rao ◽  
Shaikh Mohammed Aslam
Keyword(s):  
Elderly Patients ◽  
Predictive Value ◽  
The Elderly ◽  
Common Symptom ◽  
Deep Breathing ◽  
Isometric Handgrip ◽  
Male Predominance ◽  
Healthy Elderly ◽  
Sensitivity Specificity ◽  
Deep Breathing Test

Abstract Background Studies in healthy elderly patients have shown the prevalence of autonomic dysfunction (AD) in the range of 20 to 30%. However, there is paucity in data pertaining to AD in the elderly in the Indian context. Objective To assess the prevalence of AD in the elderly irrespective of their comorbidity status. Methods A total of 141 elderly patients with or without comorbidities/symptoms of AD were included. Demographic and clinical details of the patients were recorded. Autonomic function tests (AFTs) such as deep breathing test, Valsalva ratio, orthostatic heart rate (OHR), isometric handgrip test, and orthostatic blood pressure were performed based on Ewing’s battery of tests. The sensitivity, specificity, positive predictive value, negative predictive value, and the accuracy of AFTs were evaluated. Results Most patients (n = 85) were aged between 60 and 69 years, with a male predominance (58.87%). Hypertension and diabetes mellitus were the most common comorbidities. Postural hypotension was the most common symptom of AD. With advancing age, symptoms of AD manifested significantly more. Overall, 73.8% of patients had AD, of whom 45.4% had early AD. Number of AD symptoms, glycated hemoglobin (HbA1c) level, and comorbid factors (diabetes and hypertension) were significantly associated with the results of AFTs (p < 0.05). AFTs were highly significant with respect to the results obtained (p < 0.001). Deep breathing test, abnormal in majority of study patients, has a sensitivity of 93.3% and OHR has a specificity of 81.1% to determine AD. Conclusion The study concludes that age itself is an independent predictor of AD, which increases in severity if associated with comorbidities.

Role of high-field MR in studies of localized prostate cancer

2013 ◽  
Vol 27 (1) ◽  
pp. 67-79 ◽  
Author(s):  
Miriam W. Lagemaat ◽  
Tom W. J. Scheenen
Keyword(s):  
Prostate Cancer ◽  
High Field ◽  
Localized Prostate Cancer ◽  
High Field Mr
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